Provider Demographics
NPI:1649937780
Name:RESTORE HEALTH KLINIC
Entity type:Organization
Organization Name:RESTORE HEALTH KLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:210-290-8027
Mailing Address - Street 1:10140 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1372
Mailing Address - Country:US
Mailing Address - Phone:210-290-8027
Mailing Address - Fax:830-310-8437
Practice Address - Street 1:10140 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1372
Practice Address - Country:US
Practice Address - Phone:210-290-8027
Practice Address - Fax:830-310-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1881925691OtherNPI